The role of psychological characteristics of the personality of patients with colorectal cancer in the timeliness of diagnosis verification and prognosis of disease outcome.

OBJECTIVE: Colorectal cancer (CRC) has become the third most commonly diagnosed type of cancer in the world. Based on the risk factors for colorectal cancer (behavior, lifestyle), it is important to better understand the behavioral and psychological characteristics of the individual associated with timely seeking medical help, coping with the extreme situation of diagnosis, and the course of the disease. This determined the purpose of the study: identify the psychological characteristics of patients with colorectal cancer associated with the stage of diagnosis verification and the prognosis of disease outcome. PATIENTS AND METHODS: Coping, quality of life, and resilience, as well as clinical and sociodemographic variables were studied in 72 patients diagnosed with colorectal cancer. The design of the study involved studying the relationship between the stage of cancer and the prognosis of the outcome of the disease, as well as the role of psychological variables in the timeliness of diagnosis and predicting the outcome of cancer. RESULTS: The stage of verification of colorectal cancer is associated with the prognosis of the outcome of the cancer; the later colorectal cancer is verified, the more unfavorable the prognosis of the outcome of the oncological disease. Escape-avoidance coping is associated with the verification stage of colorectal cancer; pronounced avoidance is associated with the late verification stage. Coping strategies such as seeking social support, positive reappraisal, risk-taking, pain intensity, and role functioning significantly influence the prognosis of colorectal cancer outcomes. CONCLUSIONS: The psychological characteristics of the personality of patients with colorectal cancer have been identified, which, by determining the behavior of patients, affect the timeliness of diagnosis verification and the prognosis of the outcome of the disease.

[The psychological and environment risk factors of development of breast cancer in women residing in industrial megalopolis and rural locality].

The breast cancer hold leading position in the structure of oncological morbidity of women worldwide. The purpose of the study is to analyze contribution of psychological and environmental factors to risk of development of breast cancer in women residing in industrial metropolis and rural locality. The actuality of the study is conditioned by acquisition of new knowledge about risk factors of breast cancer. The study covered psychological factors (basic beliefs, life orientations, locus of control, coping behavior strategies, subjective assessment of quality of life, subjective age indicator, personal helplessness-independence, resilience) and environmental factor (place of urban of rural residence of women with breast cancer). The study established that in women residing in industrial metropolis the psychological risk factors are reduced indicators of basic beliefs, of quality of life and of resilience, rare application of coping strategy "Escape-Avoidance", external locus of control. Alternatively, in women residing in rural areas, psychological risk factors for breast cancer are rare application of coping strategies, reduced quality of life indicators, increased vital activity, internal level of subjective control and personal helplessness. The study results can be included in development of personalized breast cancer screening protocols and as well as considered in assessing risk of development of disease when classifying women by breast cancer risk groups.

Evaluation of Stromal Vascular Fraction Properties and Histological Changes of Regenerating Tissue during Healing of Radiation-Induced Lesions in the Rectum.

We analyzed the main properties of autologous adipose-derived stromal vascular fraction (SVF) used for the treatment of radiation-induced lesions in the rectum. No statistically significant correlation between the main characteristics of the cell product (cell number, viability) and patient's age or donor area were revealed. The stages and peculiarities of histological changes in the regenerating tissue after injection of autologous adipose tissue cells were analyzed. Morphological changes at the stages of granulation, early and complete epithelialization, and tissue maturation were described.

[Some patterns of development of radio-induced metachronous tumors].

OBJECTIVE: to determine the specific features of the development of metachronous tumors and survival rates in patients with metachronous primary and multiple cancers after radiotherapy for the first tumor. MATERIAL AND METHODS: The archival data of the Chelyabinsk Regional Oncology Dispensary on the treatment of 232 patients, in whom metachronous primary and multiple tumors occurred after radiotherapy for primary tumor, were studied. RESULTS: The patients' mean age at the diagnosis of the first tumor was 60.23 years (95% CI 58.75-61.72). The time'from the first tumor to the second one averaged 91.81 months (95% CI 80.57-103.05). The patients survived for an average of 129.41 months (95% CI 116.55-142.28) after the diagnosis of the first tumor and 37.64 months (95% CI 31.92-43.35) after the occurrence of the second tumor. Overall, the patients survived for an average of 127.03 months (95% CI 114.02-140.03) following radiotherapy for the first tumor. According to the classification, the authors identified three metachronous tumor subgroups: multicentric multiple tumors in one organ (16.0%), systemic tumors and tumors of paired organs (15.5%), and nonsystemic multiple tumors of different organs (68.5%). CONCLUSION: Patients with multicentric metachronous multiple tumors in one organ are younger and have the shortest time from the diagnosis of the first tumor to the emergence of the second one and the longest survival after the diagnosis of the first tumor, that after the detection of the second tumor and that after the initiation of radiotherapy. Patients with non-systemic multiple tumors in different organs are nlder and have the longest time from the diagonosis of the first tumor to Ine occurrence of the semetnd one and the shortest survival.

[ALPPS in case of massive liver metastases].

It was presented the first experience of ALPPS technique using in treatment of massive liver metastases in the Urals. The technique allows to carry out surgical treatment without danger of development of post-operative liver failure. Also it permits to complete treatment during one hospitalization without stretching the therapeutic process in time.

[Immediate results of combined treatment for soft tissue sarcomas including intraoperative radiation therapy].

Nowadays the most popular and justified, from oncological positions, method of treatment for soft tissue sarcomas is a combined approach with the use of conservative surgery followed by postoperative radiation therapy. In this regard, intraoperative radiation therapy (IORT) in a single dose of 10-20 Gy is a method that optimizes the role of radiation therapy in treatment of this pathology allowing precise localization of radiation zone within the "tumor bed", thereby minimizing damage of normal tissues and critical organs. The aim of the study was to investigate the effect of IORT on the frequency and structure of post-operative complications. Testing group (n = 49) was compared to the group without IORT (n = 57) and group with only surgery (n = 171). According to the study it was not obtained statistically significant differences in the incidence of postoperative complications in the groups (p = 0,57), not marked influence on the structure of post-operative complications.

[The assesment of significance of the retroperitoneal lymph node dissection in proximity of metastatic tumor with main vessels in patients with germ cell testicular tumors].

The therapeutic approach should be defined more exactly in proximity of residual retroperitoneal metastases of germ cell testicular tumor and main vessels (left after chemotherapy). The data of 29 (24%) patients were analyzed over a period of time since 2003 till 2011. The general survival was 82% in the group without lymph node dissection (17 patients) in median observation of 27.5 months. The proximity with main vessels was registered in half of the cases in the group of operated patients (12 people), a single vascular reconstruction was required. The general survival was 97% in median observation for 35 months. The involvement of main vessels of retroperitoneal space significantly complicated the retroperitoneal lymph node dissection, but didn't have negative prognostic value.

[Results of combined treatment with intraoperative radial therapy of soft tissue sarcoma].

The intraoperative radiation therapy (IORT) in combined therapy of soft tissue sarcoma in a single dose 10-20 Gy is the method, which can optimize the role of radiation therapy in treatment of this nosology. This method allows exact localization of the irradiation zone in the frames of "tumor bed", thereby minimizing the damage of normal tissues and critical organs. The aim of the study was the influence of IORT on the rate and structure of postoperative complications and long-term results of treatment in the group under study (n = 49) in comparison with the group of combined treatment without IORT (n = 57) and the group of surgical treatment. No statistically reliable difference in the rate of postoperative complications in groups (p = 0.57) was obtained and there was no influence on the structure of postoperative complications. At the same time the statistically reliable increase of general survival rates (p = 0.025) and the survival without relapse in the main group (p < 0.025) were obtained. Thus, the application of IORT in combined treatment of soft tissue sarcomas showed the satisfactory profile of "surgical safety", provided the reliable increase of general survival rates and rates without relapse.

[Long-term results of combined treatment of soft tissue sarcoma with the use of intraoperative radiotherapy].

This retrospective study of long-term results of combined treatment of soft tissue sarcoma with the use of intraoperative radiotherapy (IORT) included 171 patients. Controls received adjuvant distant gamma-therapy (n = 57) or surgical treatment (n = 171). IORT significantly improved 5 year general (p = 0.025) and relapse-free (p < 0.025) survival rate and the same parameters in patients with a tumour larger than 5 cm (p = 0.0001). The intergroup difference regardless of tumour differentiation was insignificant (p =0.33), but survival rate tended to decrease in patients with moderately and weakly differentiated sarcomas (G2-3). It is concluded that combined treatment with IORT may be used as an alternative method for the treatment of moderately and weakly differentiated sarcomas.

[Value of magnetic resonance imaging in the diagnosis of recurrent colorectal cancer].

To diagnose recurrent colorectal cancer is an urgent problem of oncoproctology. Eighty patients with suspected recurrent colon tumor were examined. All the patients underwent irrigoscopy, colonoscopy, magnetic resonance imaging of the abdomen and small pelvis. The major magnetic resonance symptoms of recurrent colon tumors were studied; a differential diagnosis of recurrent processes and postoperative changes at the site of intervention was made.

[Surgical treatment of leiomyosarcoma of the inferior vena cava].

The presented review of the literature is generalization of the currently existing data of foreign and Russian literature concerning treatment of a rare non-organic retroperitoneal tumour from smooth-muscle tissue, i. e., leiomyosarcoma of the inferior vena cava. The authors also formulate and lay down the basic principles of surgical interventions depending on the scope and level of the lesion, as well statistical analysis of the outcomes of surgical management of the this severely ill patient cohort.

[Preventive lymphadenectomy in complex treatment of melanoma of the skin, trunk and extremities].

Results of treatment of 90 patients with primary melanoma of the skin, trunk and extremities with stages T2-T4N0M0 were analyzed. Different strategies were used in relation to regional lymph nodes. It was found that prophylactic lymphadenectomy in terms of more than 4 weeks after excision of primary cutaneous melanoma reliably prolongs total and recurrence-free survival as compared with the method without fulfilling prophylactic lymphadenectomy. Prophylactic lymphadenectomy fulfilled in terms less than 4 weeks fails to have statistically significant influence on the results of treatment.

[Transesophageal ultrasonography in the diagnosis of malignant tumors of the mediastinum].

AIM: To assess transesophageal ultrasonography capabilities in diagnosis of mediastinal malignant tumors. MATERIALS AND METHODS: Technique of radial transesophageal ultrasonography was used to diagnose mediastinal malignancy in 157 patients. Method of amplitude hystography was employed to assess lymph nodes. In 84 cases diagnosis had histological confirmation. RESULTS: In 61 case out of 84 (73%) diagnosis was true. In of lymph nodes without primary tumor in the lung diagnosis was true in 72% (26 cases out of 36) and with primary tumor in 73% (35 cases out of 48). Assessment of lymph nodes sized 30 mm and more was correct in 92% (11 cases out of 12) and much higher than for lymph nodes sized less 30 mm in diameter (69%, 50 out of 72 [p < 0.001, chi2]). Correct diagnosis for lymph nodes less than 10 mm in diameter was achieved in 65% (13 out of 20) [p = 0.44, chi2], for diameter 10-20 mm accuracy was 71% (22 cases out of 31) [p = 0.96, chi2] and similar to the one for diameter 20-30 mm assessment. Location of lesion proved to be important. For lymph nodes of 3, 7, 8, 9 zones (ATS classification) precision was much higher than for other locations. There were no adverse events during the study. CONCLUSION: Transesophageal ultrasonography with the use electronic radial detector is effective an safe method of mediastinal lymph nodes and primary tumors assessment.

[Prophylaxis of early radiation injuries to intact tissues following exposure to combined photon-neutron radiotherapy for malignant head and neck tumors].

Our data are presented on comparison of early- and late-response and complications in 320 patients with head and neck tumors after combined photon-neutron radiotherapy (CPNT) alone or in conjunction with cisplatin. Laser therapy via the LGN-222 quartz installation alternating with irradiation sessions was used to prevent and palliate radiation injuries. As a result, the incidence of acute (grade I-II) reactions was significantly lowered and severe fast-neutron-induced complications were avoided. Grade I (RTOG) skin and mucous membrane injuries were rarer in the main group receiving laser therapy (2.47%) as compared with controls (8.93%) (p < or = 0.02). Grade II injuries totaled 11.6% as compared with 5.57% in control (p < or = 0.02). No damage to skin and mucous membranes in grade III-IV (RTOG) was reported. Use of cisplatin was followed by a rise in frequency of both focal (90%) and diffuse (10%) film-coated membrane epithelite (p < or = 0.02). However, radiation-related response was aborted within 10-14 days after treatment in all cases. Our procedure may be used as a method of choice in prophylaxis of severe tissue damage and CPNT-induced complications.

[Role of fast neutrons in the treatment of soft tissue sarcoma].

The report deals with our data on evaluation of combined photon-neutron radiotherapy (CPNT) received by 33 patients with soft tissue sarcoma at the Clinic of the Urals Neutron Therapy Center. Follow-up ranged 10-80 months (median--68 months). Complete response was reported in 100% (control--45%). All the patients survived 12 months after treatment (control--85%); 5-year survival was 42 and 22%, respectively. Our modality appeared to be the only means of ionizing radiation dose dispensation in cases of early relapse after photon therapy when there was a glimmer of hope of stabilization.

[Long-term results of combined photon-neutron radiotherapy for malignant salivary gland tumors at the Ural Neutron Therapy Center].

An evaluation of combined photon-neutron radiotherapy (CPNT) of malignant tumors of the salivary gland (31) is presented. Overall 1-year survival was 100%, 2 years--95%, 3 years--65%, 4 years--57% and 5 years--47%. Radiation-related injury incidence did not vary dramatically: CPNT--15%, photon therapy--11%. Most relapse occurred within the first 24 months.

[Application of compression equipment using the "form memory" effect and super-elasticity of titanium nickelide in surgery for rectal cancer].

The study is concerned with development of equipment for forming circular compression intestinal anastomosis using the "form memory" effect and super-elasticity of titanium nickelide. A sequence of technological operations is suggested, experimental tests and clinical trials carried out and immediate and end-results for anterior resection in rectal cancer are evaluated. Compression equipment for forming colorectal anastomosis proved reliable in long-term operation.

[Extended preoperative course of radiotherapy as component of combined and complex treatment of locally-advanced ampular rectal cancer].

Sixty-two patients were treated for locally-advanced ampular rectal cancer at the Center's Clinic (2004-2008). Extended preoperative course of radiotherapy plus 5 = fluorouracil chemomodification was given to 55 patients (group 1) and the same plus hyperthermia--to 27 (group 2). Radiation injuries were reported in 37.1% (group 1) and 29.6% in group 2. Surgical complications occurred in 10 (group 1) (32.2%) and 8 (group 2) (32%). Relapse was registered in 3 (group 1) (12.5%) and 3 (group 2) (13.6%). Overall 3-year survival (group 1)--82%; (group 2)--63.9%; 3-year relapse-free survival (group 1)--69.8%; (group 2)--52.2%.